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Washington rates for HCPCS K0890

Power wheelchair, group 5 pediatric, single power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,874.59 / $7,874.59 / $10,569.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $353.75
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,047.82 / $9,488.16 / $55,100.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,100.47 / $7,100.47 / $7,100.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,035.40 / $7,100.47 / $7,100.47
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $76.50 / $93.50
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79,999.20 / $79,999.20 / $79,999.20